While the COVID-19 pandemic raged on across the U.S., opioid addiction and overdose deaths steadily climbed to peak levels, too. 

Throughout 2020 and 2021, drug overdose deaths reached more than 100,000, according to the Centers for Disease Control and Prevention.

Legislators on both sides of the political spectrum have long called for stronger policies that aim to stem those rates while the Biden administration has increasingly embraced harm reduction approaches like expanding naloxone availability.

Now, a piece of legislation included in the end-of-year spending package is taking one step toward that goal by aiming to increase access to buprenorphine, a medication that’s used to treat opioid use disorder and prevent overdoses.

The bill, called the Mainstreaming Addiction Treatment (MAT) Act, removes a barrier known as the ‘X waiver.’ This requirement is that healthcare providers apply for a waiver through the Drug Enforcement Administration in order to prescribe buprenorphine. The X waiver has long been considered a major obstacle in getting more people access to a treatment which many clinicians consider life-saving.

Now, doctors and even nurse practitioners will be able to prescribe the drug more easily. The bill also allows community health practitioners to dispense the drug for detoxification or maintenance treatment without having to register with the DEA if it’s prescribed via telehealth.

Dr. Rahul Gupta, director of the White House’s Office of National Drug Control Policy, applauded the passage, noting in a statement that it’s a “major step forward in our ongoing work to ensure universal access to medication for substance use disorder care by 2025.”

Many clinicians on the ground, likewise, consider the bill a long time coming. O. Trent Hall, an assistant professor of psychiatry and behavioral health at the Ohio State University Wexner Medical Center, treats patients with addiction in the hospital and outpatient clinic daily.

“It’s important to me that access to buprenorphine is increased because we know that buprenorphine is one of only two medications known to reduce risk of death from accidental overdose and risk of serious medical complications from opioid use disorder,” Hall explained, referring to methadone as the second. “Buprenorphine, for many people, is the most accessible medication with the best chance of saving their life.”

However, the bill is also a step toward addressing the large disparities in buprenorphine access. Rural areas and communities of color have been hit especially hard during the opioid crisis, and often experience shortages of healthcare providers who can prescribe the drug, according to Sheri Doyle, senior manager with the substance use prevention and treatment initiative at the Pew Charitable Trusts.

“In particular, rural populations and communities of color have the most difficulty accessing buprenorphine,” Doyle said. “Specifically, studies have shown that Black patients are far less likely to receive this medication than white middle class patients.”

One recent study conducted by researchers at Geisinger Commonwealth School of Medicine examined several zip codes in Pennsylvania receiving buprenorphine from 2010 to 2020. While the amount of buprenorphine dispensed by Pennsylvania pharmacies and hospitals grew 217% between 2010 and 2020 — in line with efforts to fight the opioid crisis — the distribution of the medication based on location was uneven.

A 2018 study also found that physicians who had the DEA waiver to prescribe buprenorphine were unequally distributed in the U.S., with rural counties experiencing more shortages than urban areas.

The MAT Act will begin to “put a dent” in the overdose crisis, Doyle explained. Still, there are plenty of other factors that limit the ability of people to access buprenorphine.

“Getting rid of the waiver is a critically important first step, but there are other barriers to buprenorphine prescribing,” Hall said. “Some of those barriers are well outside the control of the federal government.”

There’s a patchwork of state regulations, for example, on a variety of factors — such as time limits on how long a person can be treated with buprenorphine. Because of a “codified stigma” on the medication, many states have rules that prevent easy access to it, Hall explained. There are also insurance-related barriers which de-incentivize physicians from jumping through the hoops to prescribe the medication.

Still, the removal of the X waiver is a big first step, and Hall believes it will make a difference.

“I don’t want to minimize the importance of this,” Hall stressed. “I have a hard time putting it into words — but when you meet with patients on a regular basis who’ve survived an overdose and you’re aware this medication could save their life next time — it means a lot to me as a clinician.” 

“We fully expect that this change will save lives, that it will reduce overdose deaths in our country,” he added.